Provider Demographics
NPI:1295850873
Name:TINA HARRIS PHYSICAL THERAPY, P.A.
Entity Type:Organization
Organization Name:TINA HARRIS PHYSICAL THERAPY, P.A.
Other - Org Name:TINA HARRIS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:785-462-8008
Mailing Address - Street 1:270 N FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-2322
Mailing Address - Country:US
Mailing Address - Phone:785-462-8008
Mailing Address - Fax:785-460-8080
Practice Address - Street 1:270 N FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2322
Practice Address - Country:US
Practice Address - Phone:785-462-8008
Practice Address - Fax:785-460-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-2054225100000X
KS1102054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
059714OtherBLUE CROSS BLUE SHIELD
KS650005073OtherRAILROAD MEDICARE
KS100319310AMedicaid
059714OtherBLUE CROSS BLUE SHIELD
KS100319310AMedicaid